Cola, coffee and chairs: BMJ Xmas edition

Each year, The British Medical Journal publishes a special Christmas and New Year edition that welcomes more light-hearted fare and satire from the world of science. It gives doctors the chance to let their research hair down. So what Christmas crackers have made it in? Kamran Abbasi is the editor in chief of The BMJ.

Kamran - So the first one is a study of the safety of cola in resolving what we call an oesophageal food bolus. That means, you've got something stuck in your throat, and whether or not drinking cola can relieve that. It's a question, interestingly, believe it or not, that has been studied before, though we think probably never before in a randomised control trial, which this was, done in Holland, and they evaluated 51 patients and they were either given cola to drink and they drank it in sips or they were just observed. What they discovered, possibly disappointingly, was that the cola had no effect on whether or not people's throats were unblocked and they no longer felt like choking. Although it wasn't shown to be beneficial, there was no statistically significant effect of cola drinking, in a larger sample, possibly, if they'd had a slightly different power calculation, there might be a benefit. It doesn't rule out the benefit of cola, but neither does it demonstrate it if I could encapsulate it like that.

Chris - I've heard people say that cola's a bit corrosive! But what's the mechanism of action then? Is it the caffeine that perhaps makes things constrict a bit better and pushes the stuck stuff, whatever's clogging up your oesophagus, out the way?

Kamran - Possibly long-term ingestion of cola inevitably has an effect in that way, but I think when we're talking about just having a sip to relieve something stuck in your throat, I think we're thinking that it possibly improves the motility of your oesophagus and pushes the bolus or whatever the food is that's impacted into your stomach. I'd say the mechanism is still to be determined. We don't even know that it's effective at this point.

Chris - You can try sipping some cola, but it's probably not going to make a difference. You're probably going to need to see someone who can help you out in a different sort of way. Now, the next story you've got for me is one very close to my heart because it concerns what I do for a job, where I work, but also a substance which I can't live without.

Kamran - There's quite a drinking theme here in this year's Christmas issue. So this is all about coffee. We all want coffee at work - we're the same at the BMJ. We're all crowded around the coffee machine.

Chris - We call it the medicine dispenser.

Kamran - Yeah, precisely. So what we are looking at is whether or not, by touching those machines, we might be spreading infection. And of course all that's very topical with everything that's just happened with the pandemic, whether it's being encouraged to wash our hands and sterilise surfaces. One of those surfaces we've probably forgotten about is the good old coffee machine. This study looks at whether there are pathogens on coffee machines from different bits of coffee machines and it finds that there are. So, the question then is, should we be concerned about that or not? What these researchers find is, they tend to be commensal or atypical pathogens, ones that aren't medically relevant. So the bottom line is there are pathogens there, still wash your hands and obviously clean the machines - that's good practice and to be encouraged - but what we don't want and we aren't supporting is a ban on coffee machines. So I think this is good news.

Chris - Phew, I'm relieved. And to round up, I would say to finish us off, but that's got the wrong sort of connotation, hasn't it? This one is all about patient satisfaction, very important, but where the physician is and sits and where you put chairs. I'm intrigued. Tell me more about this one.

Kamran - Yeah, exactly. We do want to publish papers with a serious message and there's something serious here, which is about better communication with patients. If you've been in hospital either as patients or visiting somebody, you often see the medical team or the surgical team wandering around the hospital, going from patient to patient, and the question these researchers are asking, by sitting next to the patient, by facing them, whether or not that means that there's better patient satisfaction in the encounter. What they found is that, first of all, by putting a chair there, inevitably it means that the consultant or the doctor sits down more often. That's no surprise. But secondly, the patients feel more satisfied by the conversation. And thirdly, it doesn't seem to take up more time than if they just stood.

Chris - So this was the mere fact that if you put a chair with a patient in the right sort of position in relation to the patient, then the person who's talking to the patient comes and sits in it so you get a sort of more eye level conversation rather than somebody looking down on top of you, as it were?

Kamran - Yeah, exactly. And I think one of the criticisms of traditional medicine is that it's very patriarchal: somebody very senior comes to see you in hospital, they tower above you, they talk down to you, don't listen very much to what you've got to say as the patient. This is changing that power dynamic in that you're sitting down, you're the same eye level and that enables a conversation and should encourage you as the doctor to listen more to the patient, should encourage the patient to feel that they're speaking more directly, on the same level with their clinician. So clearly, again, we need to see whether something as simple as this could lead to any clinical benefit. We may never be able to demonstrate that, but surely this has to be one of those situations where anything that encourages a better conversation has to be a good thing.

Chris - The people in charge in the hospital, of course, are the infection control team. So what do they say about this? Are they happy with the doctors sitting on the chairs spreading diseases?

Kamran - Haha. Yeah, I'm not sure a doctor sitting on the chair is the most problematic mode of transmitting diseases. We've already banned ties from hospitals because they might be a vector of transmission - there wasn't much strong evidence around that. I don't think sitting on a chair is going to cause problems. If anything becomes widely adopted, there'll always be people who try to stop you doing it, but I can't see that mechanism personally.